Provider Demographics
NPI:1588784664
Name:LEVY, JOEL KUTNER (PHD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:KUTNER
Last Name:LEVY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 HUMMINGBIRD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4922
Mailing Address - Country:US
Mailing Address - Phone:713-569-9948
Mailing Address - Fax:
Practice Address - Street 1:6315 GULFTON ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1107
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:713-457-0945
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX23083103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23083OtherTEXAS PSYCHOLOGIST LIC.
TX620005535OtherRAILROAD MEDICAREPROVIDER
TXR59835Medicare UPIN